“It’s Not All Sunshine and Lullabies”

It’s Not All Sunshine and Lullabies

L & D is not always the happiest place in the hospital. Consider the case of Ms. H. Ms. H is a healthy 35 year old female, at 28 weeks gestation with her 3rd child. Thus far the pregnancy has been uncomplicated. One Friday morning, on her way to work Ms. H notices that the baby, a girl, is not moving as much as normal, so she calls her OB and arranges to come by for a quick check. Ms. H’s BP is up and her weight has gone up several pounds, much of which appears to be edematous. The doctor checks the fetal heart rate, which is 127. He offers her the option of going to the hospital for an ultrasound, which Ms. H accepts. The hospital can’t get her in for several hours, so the office nurse advises Ms. H to go home and try some caffeine to get the baby moving.

After waiting at home and still not feeling the usual amount of fetal movement, Ms. H drives herself to the hospital for the ultrasound. When the tech begins the ultrasound, she quickly stops and steps out to answer the phone, stating that the secretary is gone for the day, so she has to help at the front. The tech is gone for an unusually long time. Finally the tech comes back in the room accompanied by Ms. H’s OB. Ms. H immediately bursts into tears, sensing that whatever is coming is going to be unbearably painful. The MD takes her hand and simply says “It isn’t good”. The baby was dead and possibly had been dead for quite some time. The doctor gives Ms. H some options. She can go home, pack and come back the next day for induction of labor or she could go up to the floor immediately to start the process. He explains potential complications: infection, bleeding, DIC. He offers to order her Ativan and Ambien. Ms. H decides to go up to the floor for immediate induction.

The OB accompanies Ms. H upstairs and promises to call her husband, as she is still quite tearful. The doctor leaves to go write admission orders. Elizabeth, a veteran L & D nurse from Ireland, appears and gives Ms. H a hug. She gets Ms. H settled into a room, obtains a urine sample, and applies the ID bracelet. Soon it is shift change. Stacey, another veteran L & D nurse, introduces herself to Ms. H and hugs her also. Stacey inserts an IV and draws blood in a rainbow of tubes for stat labs. The OB returns and inserts Cytotec into the vagina to initiate the induction process.

The lab results come back quickly. Ms. H’s white count is high. Her platelet count and RBC’s are slightly low, and her liver function tests are abnormal, not the best findings. The OB orders two IV antibiotics to counter any infection that is present and then leaves the hospital for the night. Ms. H’s husband arrives amidst more tears. The nurses contact a representative from a local support group for parents of stillborn infants and infants who die shortly after birth. The representative will later come visit Ms. H in the hospital.

Because of their other children, Mr. H has to leave for the evening. Stacey gives Mrs. H an Ambien and checks on her periodically throughout the night.

In the morning an infusion of Pitocin is started by Elizabeth, who has returned for the day shift. Elizabeth also hooks up a Dilaudid PCA, so that Ms. H will have some pain control. Ms. H is alert and oriented and occasionally tearful. Her spouse stays with her throughout the day. Elizabeth assist Ms. H in filling out the forms required for a death certificate. Ms. H names the baby Anna Elizabeth. As the day shift goes on, contractions begin and eventually grow stronger and more painful.

When the night shift staff comes on duty, Stacey returns along with a new grad RN, Candace, to take over care for Ms. H. The PCA is no longer providing sufficient pain relief. The nurses suggest an epidural, to which Ms. H readily agrees. Sheila, the charge nurse, comes in to help set up for the epidural. The Anesthesiologist arrives and coaches her CRNA student through inserting the epidural. Ms. H relaxes considerably once she obtains adequate pain relief. The OB returns and decided to do an amniotomy, breaking the water. Once the doctor leaves, the contractions increase in frequency and strength. Stacey, Candace, and Sheila all are present to deliver the stillborn baby.

The nurses whisk the baby’s small body off to the next room, where they clean her and wrap her in a blanket. The nurses obtain her handprints and footprints. They put a hat on her head and take photos of her. Then Stacey and Candace take the baby to her mother. Tears stream down Mrs. H’s face. Ms. H holds her baby and looks at her lovingly for a very long time as if trying to take in all the details and commit them to memory. The baby has fair white skin and lots of dark hair. Her eyelids are still tightly shut.

Eventually the nurses take the baby back, and Candace takes her body to the morgue. Stacey gives Ms. H an Ambien. The OB arrives back at Ms. H’s room and delivers the placenta without complications. Ms. H’s husband returns home to their children. Stacey and Candace pop in at least hourly throughout the rest of the night to assess Ms. H’s mental and physical status.

In the morning RN Elaine takes over Ms. H’s care. Elaine has been in L & D for 30 years. Ms. H’s husband and other two children are present at the bedside. Ms. H requests a chaplain to pray with them. Elaine asks if she would like the baby present for the prayer. Ms. H considers this and agrees, stating “Maybe it is the only thing I will ever be able to give her”. It is a Sunday, so the main hospital chaplain is presiding over mass at his home church. Elaine calls and calls, everywhere she can think of. There seem to be no available ministers anywhere in the entire metropolitan area. Eventually a tall, bald man wanders into the room, introducing himself as one of the hospital’s assistant chaplains, stating he had just stopped into the office for a moment and saw the message. Elaine brings the baby to the room, and the chaplain and family hold hands and pray. The two other children, 7 and 9, appear interested in the baby and both hug her. The chaplain leaves, and Elaine returns the body to the morgue,where an autopsy will eventually be performed. Elaine Brings Ms. H a decorative box, which contains a sympathy card signed by the nurses, the baby’s blanket and hat, copies of the footprints and handprints, as well as the photos. Ms. H is discharged to home at approximately 1500. –

These were some damn good nurses, who did their utmost to make a horrendous, heartbreaking situation at least somewhat bearable. I was not one of the nurses this time. In fact, I was the patient, Ms. H. Being the patient totally sucks, but when overcome with grief, it is excruciating. Those nurses gave me 100% and I took it greedily and gratefully. Now when I give a hug, hold a hand, or look in a face contorted with grief and pain, I draw on what those L & D nurses gave me in the midst of my deepest, darkest moments. Their love and compassion flow through me to my patients as though from a well that never run dry.

**One year and 3 months from the date of the loss of Anna, I gave birth to a healthy 9 lb baby boy. Life is good**